Windsor Health Group Selects MedHOK’s Single Platform for Care, Quality and Compliance for Clinical and Compliance Programs

Posted in Press Releases on Tuesday, August 07, 2012.

TAMPA, Fla. – August 7, 2012 – Windsor Health Group and MedHOK, one of the healthcare industry’s fastest growing software companies, announced today that Windsor’s Medicare Advantage business, Windsor Health Plan, Inc., will deploy MedHOK’s single platform for care, quality and compliance to proactively close care gaps, enhance care management, improve Star scores and ensure compliance.  In doing so, Windsor is positioning itself to succeed in the rapidly changing healthcare environment that is emphasizing care and quality outcomes.

MedHOK offers fully NCQA certified software for HEDIS®, Pay for Performance and Disease Management performance measures. The company has more than 18 million lives in production and is on track to double this number within the year.

Nashville-based Windsor Health Plan, Inc., which provides Medicare Advantage and standalone Part D prescription drug plans for more than 157,000 Americans, will use MedHOK’s platform  to bolster care management quality for its members across 28 states:

  • MedHOK’s 360Member™ solution to increase its commitment to member-focused care
  • Utilization Management
  • Pharmacy Coverage Determinations and Redeterminations
  • Case and Disease Management
  • Predictive modeling and stratification
  • Part C and Part D Star improvement, quality and care gap closure
  • Pay for Performance
  • Grievances
  • Appeals
  • CMS Complaint Tracking Modules (CTMs) and general complaints
  • Independent Review Entity and external appeals
  • Correspondence/fulfillment, dashboard, reporting and audit functionality

“Windsor Health Plan and our employees have as our highest priority to ensure that our members receive the best quality of care available in the markets we serve.  Our strategy is to continue to invest in comprehensive clinical and member management systems like MedHOK that help improve quality and virtually every facet of the user experience for both our members and providers alike. We know that future success depends on constantly driving quality improvement and providing excellent service that our members expect and deserve,” said Michael A. Muchnicki, Chief Executive Officer of Windsor Health Group.

MedHOK’s integrated care management, quality and compliance platform facilitates improved clinical outcomes and care coordination while enhancing quality measures, compliance and financial performance. It accomplishes this by:

  • Providing real-time access to Star, HEDIS, pay-for-performance (P4P), and proprietary quality and performance measures, helping plans and providers to accurately monitor in real-time the data they need to achieve and maintain high quality ratings.
  • Triggering interventions when care gaps are identified, in particular for patients with multiple co-morbidities and chronic conditions.
  • Utilizing predictive analytics models to generate profiles based on clinical, quality and financial data for member, provider and local populations.
  • Calculating risk scores for every member, enabling timely predictions of those at the highest risk for more accurate forecasting of care costs and utilization.
  • Continuously monitoring for and addressing regulatory changes from CMS and state Medicaid agencies, ensuring clients stay ahead of the compliance curve.

“With the passage of health reform, all lines of business will see revenue directly tied to care, quality and compliance outcomes.  Health plans will need to deploy the right technologies that enable continuous monitoring of key care and performance measures,” said Anil Kottoor, president and CEO, MedHOK. “MedHOK’s single platform for care, quality and compliance is built for health plans and other entities seeking to succeed in this new rigorous, results-oriented environment.  We are proud to partner with Windsor to meet their future needs.”

About MedHOK

Tampa, Fla.-based MedHOK has more than 18 million lives in production and expects to double that number in 2012, making it one of the healthcare industry’s fastest-growing software companies. It offers a cloud-based integrated software platform for care management, quality and compliance that enables physicians, ACOs, PCMHs, payers and TPAs to manage and measure care against national quality standards for optimal outcomes. Its innovative modular software helps healthcare organizations meet quality, care and compliance objectives across business lines by facilitating real-time information sharing with all stakeholders to address disease management and care coordination, clinical quality and utilization review, and quality and financial measures. ICD-10 compliant, HIE-ready and securely accessible on any device, the MedHOK platform is user-friendly, rapidly deployed and easily configurable for a low total cost of ownership and rapid return on investment. It holds 2012 HEDIS®, Pay for Performance and Disease Management performance measures certification.

About Windsor

Windsor Health GroupSM refers to Windsor Health Group, Inc., an insurance holding company and its operating subsidiaries, which include Windsor Health Plans, Inc. (WHP), and Sterling Life Insurance Company (SLIC). WHG, through WHP and SLIC, serves more than 230,000 Americans with a variety of insurance offerings for the senior population. WHG is a subsidiary of Munich Health North America, Inc., which is a subsidiary of Munich Reinsurance Company (Munich Re), one of the world’s leading reinsurers.

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